THE BIG FOUR
Read before the Innominate
It would of course, be ridiculous to undervalue or attempt to detract from the accomplishments of modern research. New instruments and procedures, organ transplants and vascular by-passes, miracle drugs, spectacular diagnostic tests, etc. have revolutionized the care and cure of patients. Experiences in my own family can be duplicated in most of yours. A grandfather died of cancer of the stomach in his sixties. Excusable delay in diagnosis allowed the disease to advantage to a stage where widely extensive surgery was required and was unsuccessful. My mother’s mother died of diabetes in her fifties. She said she would rather die than diet and was her only choice. With insulin, my mother controlled her diabetes until she died in her eighties. Another relative in shock from an extensive coronary might have been diagnosed as “Cholera Morbis” before the advent of the electrocardiograph. With his blood thinner he resumed his normal activities. Transfusions are no longer major procedures and refined typing technique has largely eliminated even minor reactions. I have mentioned these things to show that I do appreciate and am grateful for the many advancements that have been made and become available to all us.
However, none of this progress has caused me to lose my appreciation, but rather to increase my admiration and respect, for the great clinicians with whom my class of 1921 had contacts. Most were excellent teachers and kept themselves well informed. Practically all were on a voluntary basis and took pride in keeping their school commitments.
In medicine, Dr. Wm. A. Jenkins was outstanding. One of the younger men was Dr. Morris Flexner who had just returned to Louisville with marked appreciation and enthusiasm for newer laboratory procedures. Dr. John Walker Moore was a pioneer in blood chemistry knowledge. Dr. Emmett Horine graduated from anesthesiology to early cardiology. Some might include Dr. Virgil Simpson, but most of us would not agree with the inscription on his tombstone:
"I burned my candle at both ends;
it did not last the night.
But Oh! my friends,
it gave a lovely light.”
Dr. John Moren, in neurology, and Dr. Wm. E Gardner, in psychiatry, were excellent teachers and demonstrators of history-taking in their respective fields, showing marvelous insight into human nature. Dr. Gardner had a hospital on 6th near Magnolia called the Louisville Neuropathic Institute. I well remember a friend of mine who had gone there to boil out after he and his girl friend had been communing nude with nature in the woods for a few days. Dr. Gardner asked me to see him because of some badly infected leg ulcers. This patient made one of the few complaints I ever heard against Dr. Gardner, whispering to me that the institute was a hell of a place having live owls in his room and naked women sitting on the tree branches outside his window.
In pediatrics, Dr. Philip Barbour was the dean with Drs. Henry Tuley, James Prichet and Jim Bruce working at the new specialty.
Drs. Adolph Pfingst and Claude Wolfe were outstanding ophthalmologists and Drs. Sam Dabney, Walter Dean and Gaylord Hall were prominent in the ear, nose and throat field.
Dr. Oscar Miller was becoming well known as an expert in chest diseases.
Drs. Bernard Asman and Granville Hanes were establishing proctology as a specialty.
Dr. Ben Bayless and Drs. D. Y. and Paul Keith were active in the field of roentgenology and, incidentally, instead of films they used glass plates covered with emulsion.
Dr. Stuart Graves was upgrading pathology to the high level it enjoys here today.
Dermatology was well covered by Drs. N. Bloom and Wm. J Young.
My particular interest, however, was in surgery. Among the older men retiring at that time were Dr. W. O. Roberts who had the L & N Railroad surgery, Dr. Wm. Dugan who had come out of retirement during World War I, Dr. Horace Grant who devised a metal gimblet for fracture fixation, and Dr. Lewis McMurtry, a debonair gentlemen of the old school who was also a most competent gynecologist.
In the group of younger men were Drs. Walter Hume, Sr., Wallace Frank, M. J. Henry, Ray Ellars, Misch Casper, D. Y. Roberts and Guy Forsee. Dr. John Price, Jr. was one of the best-trained younger surgeons of that time. Dr. George Coons did most of the surgery for the homeopathic physicians.
Dr. George Hendon invented a beef bone key to lock fractures in place, although one of his aggressive competitors called attention to the fact that a key unlocks as well as locks. Dr. Hendon was also interested in intestinal obstruction and did some early work in tube enterostomy.
Drs. Elmer Henderson, Calvin Arnold, Guy Grigsby, H. H. Hagen, Guy Aud and Frank Strickler were becoming active in general surgery, and Drs. Barnett Owen and I. A. Arnold were pushing the specialty of orthopedics.
There were also many others whom I do not wish to slight by not mentioning names but the above are a good cross-section of our teachers, when considered with the individuals discussed next, and who were my outstanding heroes. They were a group of surgeons in between these two age brackets I have enumerated. When one considers how individualistic their personalities were, it is surprising how many things they had in common. All had preliminary college educations, uncommon for medical students at that time; all had their medical education in Louisville, which is a real tribute to the local physicians who taught them, and three of the group interned at the Louisville City hospital and followed that service with studies in Europe.
All were in their prime, physically and mentally, and possessed unbounded energy. While they were stiff competitors, none ever berated any of the others. They were cultured and intelligent gentlemen, well dressed and possessing indefinable, but easily recognizable, something called quality or class. They made an excel1ent appearance and were most friendly to everyone and to each other, but each had a non-tangere type of reserve. Few called any of them by his first name or patted him on his shoulder. All were elected to membership in the Southern Surgical Association.
They were all industrious, fair in their charges, kind to their patients, and of unquestioned integrity. They were all-around general surgeons at a time when there were only rumblings of the coming sub-specialties in surgery.
This group of men, Drs. Irvin Abell, Sr., Louis Frank, J. Garland Sherrill and John R. Wathen were frequently, and in my opinion, properly referred to as “The Big Four”.
While Dr. Wathen was a distant relative by marriage, I had less personal contact with him than with any of the others. His father was Dr. William Wathen, an outstanding gynecologist in our city. He was a Yale graduate and a truly intellectual man. His medical training was received here in Louisville. In his early days he wrote a book on the Essentials of Histology which was a standard text for some time. His two specialties were prostatic and goiter surgery, especially the latter. Most of his work was done at St. Anthony Hospital where Dr. Walter Hume, Sr. frequently assisted him. He always had an abundance of excellent instruments and kept them in perfect condition. I have seen him use a hundred clamps during a thyroidectomy. He was an avid reader of contemporary professional literature. While his manner was at times egotistical, he had good reasons for feeling as he did. In many ways he was a lone wolf but not the ferocious type. He had the respect and admiration of his colleagues.
The other three men I knew very well. Dr. Frank was a native of Paris, Kentucky and received his early education there and some college wok at Transylvania College. His medical education was completed here in Louisville where he won the first honors of his graduating class. After an internship at the Louisville City Hospital, he went to Germany studying under Koch at Berlin and Von Recklinghouse at the University of Strasburg where he was offered, and declined, a permanent position. My acquaintance with him began when I was a little boy. My brother and I had scarlet fever when my mother gave birth to a third child at home. She apparently developed a scarlitinal infection of her genital tract and was desperately ill. Someone suggested to Dad that a brilliant young surgeon named Louis Frank be called in consultation. (Old Dr. W. O. Roberts had previously done Dad’s surgery.) Dr. Frank made the diagnosis, put her on Dichloride of Mercury irrigations, came over every day on the ferry boat to Jeffersonville to treat her, and she recovered. Dad felt eternally grateful to Dr. Frank and referred practically all of his surgery to him after that. Dr. Frank was aggressive and a vigorous and sparkling debater. Although he carried on hot arguments, he could be most ingratiating afterwards and seldom lost any friends. The same was true of his activities and actions in school affairs and in the operating room. Dr. Frank was the son of a tailor and apparently inherited some skill in sewing. He was a meticulous gentle surgeon and his intestinal work was beautiful. Some of you might be interested in knowing that part of his surgical armamentarium was a thimble, always included with his instruments.
He was kind enough to recommend me for examination for a surgical internship at the New York Post-graduate Hospital and I am sure had something to with securing my appointment. When my training was completed he took me into his overcrowded office, gave me desk space in his library plus $50.00 a month and the privilege of doing personal private cases. At the time he had thoughts of organizing a surgical group including his son, Wallace, Wallace’s classmate, Dr. J. P. Boulware, and me; however, Wallace was not enthusiastic about such an arrangement and things continued on a rather loose basis for about six months until one day, at the old Jewish Hospital at Floyd and Kentucky, I was brought in as a third assistant at a hemorrhoidectomy. The scrub nurse pulled off her gloves in disgust and when I talked it over with Dad that night, he advised me to start out on my own, which I did the next day. Dr. Frank and I stayed on good terms and I continued to have operating privileges at Norton whenever I could get a case, a privilege I am sure he could have stopped at any time. My only later unpleasant contact with Dr. Frank came when we were sitting next to each other at a faculty meeting where I was recommended for a promotion. Dr. Frank rose to his feet, placed one hand on my shoulder and said, “I love Duffy Hancock like a son, but he is not ready yet for this promotion.” However, it was approved and we walked out of the meeting together as friends and remained so. I still remember with gratitude the many favors he did for me and the many things he taught me surgically.
Dr. J. Garland Sherrill was a native of North Carolina where he obtained his preliminary and liberal arts college education. Once he moved to Louisville for his medical education, he became and remained a firmly rooted Kentuckian. After interning at the Louisville City Hospital he became a demonstrator of operative surgery, and later went to England and Scotland to study aseptic surgery. He was a most pleasant gentleman with a beautifully modulated voice. His pleasant smile had a suggestive pixie-like appeal. He was a daring surgeon at a time when some were restrained by timidity. His inoffensive egotism was based on experience, and not on arrogance. More than once I have heard him say, when asked to do some difficult case, that “it would have been apple pie for Papa”. He did some pioneering work in vascular surgery and spinal anesthesia. In contrast to Dr. Wathen and Dr. Frank, he used a relatively small number of instruments. He was an exceptionally good extemporaneous speaker and a prolific writer, contributing over l00 articles and writing a monograph on Peritonitis, which I had the privilege helping to proof-read. He had allowed me to share his reception room after I left Dr. Frank. Towards me and all younger men, he was most kind. In a truly masculine way he was a lovable personality and a loyal friend. He never offended others by derogatory remarks or acrimonious discussions.
He volunteered for duty in World War I serving at Rockefeller Institute, Walter Reed Hospital, a base hospital in South Carolina and finally, in an Evacuation Hospital in France. He resumed active practice operating in many of the hospitals in this area. At one time he was a delegate to the AMA and was orator in surgery at the KMA before that custom was discarded. He had no hobbies or vices except gambling, which was but another expression of his self-confidence, but not as rewarding as his daring in surgery. Death was preceded by prolonged complications and reverses, but his endearing qualities lasted to the end.
Dr. Irvin Abell, the other surgeon among "The Big Four" was a most remarkable man in many ways and his fame, local and national, was outstanding.
He was a native small town Kentuckian receiving his preliminary education in his hometown and his college work in Kentucky before beginning his medical education here in Louisville. He, too, interned at the Louisville City Hospital and afterwards did further work and studies in Europe at the Universities Marburg and Berlin. Upon his return, he began his affiliation with our medical school and continued it until his death. He was an all around surgeon. As a matter of fact, his lectures to our class one-year dealt with surgical diseases of the kidneys. He was an amazing exemplification of the old adage, “If you want something done get a busy man to do it.” I have never seen anyone so well organized, accomplishing so much with no apparent rush.
At the old St. Joseph Infirmary on 4th Street there were two operating rooms - a large one and a small one. Dr. Abell used the large one, and all the rest of us shared the small one. When the new hospital was built in 1926 on Eastern Parkway, he was assigned a suite of two operating rooms and would walk from one room to the other case after case every morning. The volume of work he did was almost unbelievable and it continued for many years. Along with this volume of surgery, he too wrote and published over 100 articles and found time to be a member of the Board of Trustees of the University of Louisville, a director in a bank, a director in an insurance company and in the Franklin Martin Memorial Foundation, as well as Chairman of the Medical Advisory Committee of the National Foundation For Infantile Paralysis. He had a distinguished surgical career in France during World War I. He was a devoted Catholic and most active in church affairs. For recreation, he enjoyed hunting and fishing and horse racing all of his life.
He was a truly noble character and a kind man kind to his patients and kind to younger doctors. He was under no obligation to me, and my father never referred any cases to him except hide-bound Catholics who would not go anywhere else. Yet, he did me many favors when I was beginning practice and I am sure I was no isolated case. He helped many others. I never heard of him making a derogatory remark about any other doctor. He reminded me of what old Dr. J.N. McCormack once told my class in a talk on Medical Ethics. After telling us we should always speak kindly of other doctors, one of the men in my class asked him what we could say about someone we knew was dishonest and incompetent. His answer was that we could always say "I do not know him well, but those that have him seem to like him.” To me, Dr. Abell gave the impression of that unperturbability or equanimity described by Osler. In his personal contacts and his professional work he never appeared frustrated, aggravated or hurried. Dr. Harry Woodard, who gave many anesthetics for Dr. Abell once said the only sign of impatience he ever saw Dr. Abell show was to pat his foot on rare occasions. He did not appear to be the rapid or brilliant surgeon that he was simply because he had no lost motions.
Often a man is not appreciated until he is dead. Happily, Dr. Abell's multiple accomplishments were recognized during his life time. He was president Of the Jefferson County and Kentucky State Medical Societies, the Southern Medical, the Southern Surgical, the Southeastern Surgical, the American Gastro-Enterological, the Association of Military Surgeons, the American College of Surgeons and the American Medical Association. He was awarded Notre Dame’s Laetare Medal and six honorary doctorate degrees, four in science and two in law, and was made an honorary fellow of the Royal College of Surgeons of England. He was also created a papal knight. Through it all he was modest, unassuming and most pleasant socially.
His loyal friend and assistant of many years, Dr. M.J. Henry borrowed the following eulogy to apply to Dr. Abell:
"And so I am glad;
Not that my friend is gone,
But that the earth he laughed and lived upon
Was my earth too.
And that I had gladly known and dearly loved him,
And my love for him I had shown.
Tears at his departure? Nay, smile
That I could walk with him a little while.”
All who knew Dr. Abell well could subscribe to these sentiments.
These then were my Heroes. The practice of medicine has many compensations - money is the least. Few of us are able to accumulate much since as income increases, so do overhead and private and public financial obligations in keeping with advancing monetary status in life. The two real rewards are the opportunities for service to our fellow men and for contacts with other physicians. All of us will not be at the genius level of those four, but most physicians are intelligent, personable and pleasant to work with and know. We are a fortunate group to have such associates.
“The Big Four” were the men who did so much to establish Louisville as a surgical center. These individuals have been gone for some time but the breed lives on. Even in our small society there are four men of my age group who have the essential attributes of the Big Four. They are: John Bate, Arnold Griswold, Malcolm Thompson and Pat Imes. They, and also some non-members, have shown the skill and professional conduct that bridges the gap between the Big Four and the Enlightened Eighty — that group of competent young surgeons serving our community today and offering such devastating competition to their elders.